In their article titled “Redesigning a Joint Replacement Program Using Lean Six Sigma in a Veterans Affairs Hospital,” Gayed et al1 were able to reduce length of stay for total joint replacement by 36% and eliminate contracted care. The volume of total joint replacement increased, and $1 million dollars in savings was achieved without affecting the quality of care. This work is but one example of the widespread ferment of change across Veterans Affairs (VA) health care.